Active NPI
Jerry E. Young, D.D.S., P.a.
- General Practice Dentistry
- Holton, KS
National Provider Identifier
1578664330
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4625
- Legal business name
- JERRY E. YOUNG, D.D.S., P.A.
- Practice address
- 208 West 4TH Street
Holton, KS 66436 - Phone
- (785) 364-4636
- Fax
- (785) 364-4815
- NPI assigned
- Sep 26, 2006
- Last updated
- Aug 22, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Jerry E Young, DDS
- Title
- President
- Phone
- (785) 364-4636
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4625 | KS | Primary |
Addresses
Primary practice location
208 West 4TH Street
Holton, KS 66436
Mailing address
208 West 4TH Street
Holton, KS 66436
Phone (785) 364-4636
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 17207 | Other | KS | BLUE CROSS & BLUE SHIELD |
| 627506 | Other | KS | UNITED CONCORDIA |
National Provider Directory
National Provider DirectoryLocations
208 W 4th St
Holton, KS 66436
Phone (785) 364-4636
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- General Practice Dentistry
- Holton, KS
- NPI 1669573424
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1578664330",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "208 WEST 4TH STREET",
"city": "HOLTON",
"state": "KS",
"postal_code": "66436",
"telephone_number": "785-364-4636",
"fax_number": "785-364-4815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "208 WEST 4TH STREET",
"city": "HOLTON",
"state": "KS",
"postal_code": "66436",
"telephone_number": "785-364-4636",
"fax_number": "785-364-4815"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "JERRY E. YOUNG, D.D.S., P.A.",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-26",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "YOUNG",
"authorized_official_first_name": "JERRY",
"authorized_official_middle_name": "E",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "785-364-4636",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "KS",
"license": "4625",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS & BLUE SHIELD",
"identifier": "17207",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "627506",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Holton, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.